CRITICAL CARE SCN · Process Improvem ents (PDSA Cycle); and monthly audit & ... through continuous...
Transcript of CRITICAL CARE SCN · Process Improvem ents (PDSA Cycle); and monthly audit & ... through continuous...
CRITICAL CARE SCNPROVINCIAL DELIRIUM INITIATIVE
C r i t i c a l
C a r e S C N
Alberta’s
Critical Care Community Edmonton & Calgary Pediatric ICUs:
• ACH PICU
• Stollery’s PICU
• Stollery’s PCICU
Edmonton Adult ICUs
• RAH GSICU
• UAH Burns
• UAH GSICU
• UAH Neruo
• MAZ CVICU
• Sturgeon ICU
• MIS ICU
• GNH ICU
North Zone:
• NLHRHC Fort McMurray ICU
• QEII Grande Prairie ICU
Central Zone:
• RDRHC ICU
South Zone:
• Chinook Lethbridge ICU
• Medicine Hat ICU
Calgary Zone:
• FMC ICU
• FMC CVICU
• PLC ICU
• PLC CCU
• RGH ICU
• SHC ICU
C r i t i c a l
C a r e S C N
C r i t i c a l
C a r e S C N
Partnering for Quality Health System
• Provincial scope• 22 ICUs• Multidisciplinary• Operational &
Medical leaders • Interdepartmental Partnership
• Inform future practice• Contribute to body of
evidence & research
C r i t i c a l
C a r e S C N
Transforming Information into
Action
Westfall, J. M., J. Mold, et al. (2007). Practice-Based Research--"Blue Highways" on the NIH Roadmap. JAMA 297(4): 403-406.Khoury, M. J., M. Gwinn, et al. (2007). The continuum of translation research in genomic medicine: how can we accelerate the appropriate
integration of human genome discoveries into health care and disease prevention? Genet Med 9(10): 665-74
The Breakthrough Series
Learning Collaborative
Initiate, Engage
Stakeholders& Plan
Innovation Collaborati
ve Learning
Session #1: Learn,
Level-set provincially
, Plan, Report Out
Collect & Report
Baseline Data
Site Implementation Team
Process Improvements (PDSA
Cycle); and monthly audit &
report of measures
Learning Session
#2: Learn, Share, Plan,
Report Out
Site Implemen
tation Team
Process Improvem
ents (PDSA
Cycle); and monthly audit &
report of measures
Learning Session
#3: Learn, Share, Plan,
Report Out
Site Implementation Team
Process Improvements (PDSA
Cycle); and monthly audit &
reporting of measures
Probable Learning Session
#4
Transform ICU
Delirium Care
through continuous
quality improveme
nt
Current State of the CC-SCN Provincial Delirium Initiative
Nov. 2016 Feb. 2017 Feb. – May 2017 May 2017 May – Sept. 2017 Sept/Oct 2017 Sept. – TBD 2017
C r i t i c a l
C a r e S C N
Building a Quality System
Evidence based
practice
Improvement
Methods
Analytics
Measure to Improve – a ‘framework’ required
Example of one indicator of ‘effectiveness’
Data Elements: Administrative Data (AHS/AHW) plus Clinical (Physician) Data
•DAD, CIHI, Statscan•Billing and Emergency Data
•Physician Clinic Data
Key Indicators:• Volume of patients/yr•% in defined risk groups•% admitted to hospital•% readmitted to hospital
Key Composite
Indicator (CI) •Risk-adjusted
outcome improvement/year
DATA
KEY INDICATOR
KEYCOMPOSITEINDICATOR
• Review your progress
• Evaluate your Plan
• Make adjustments
• Report & Share
C r i t i c a l
C a r e S C N
Information Value Chain
C r i t i c a l
C a r e S C N
The Process• Determine Key Performance Indicators (KPIs)
• Figure out how to operationalise them!
• What are the inclusions, what are the exclusions, what is the workflow?
C r i t i c a l
C a r e S C N
KPI Measures Template• Relationship to Quality
• Type of Indicator
• Proposed Data Sources
• Definitions
• Numerators
• Denominators
• Benchmark
• Risk Adjustment
• And many more fields!
C r i t i c a l
C a r e S C N
The Pain Dilemma• % of compliance with documented q4h pain
assessment o Number of assessments in a day?
o Timing between assessments?
o Hard cuts off and intervals?
C r i t i c a l
C a r e S C N
The Pain Solution
%Compliance =
100x[1-(cum_sum_4hr)/24]
• cum_sum_4hr = cumulative sum of time in 24 hr period where interval between measures exceeds 4 hrs
C r i t i c a l
C a r e S C N
Reporting - The house that
delirium builtD
atab
ases
QA
Fro
ntl
ine
Staf
f
MetaVision
Data
TRACER
Data
Other systems
C r i t i c a l
C a r e S C N
Optimisation and Evolution
“Perfection is the enemy of good”
C r i t i c a l
C a r e S C N
TRACER Web Reports
24/7!
C r i t i c a l
C a r e S C N
TRACER Web Reports
C r i t i c a l
C a r e S C N
Ever Delirium - Percent of patient days where patient was delirious.
C r i t i c a l
C a r e S C N
C r i t i c a l
C a r e S C N
Mobilization – 3 x’s per 24
hours
Goal = Daily mobilization
Pain Management
Sedation
Readiness
Workflow & routines
C r i t i c a l
C a r e S C N
Change Tools – Fishbone
DiagramCause and Effect Diagram
PEOPLE ENVIRONMENT
MATERIALS METHODS EQUIPMENT
Mobilization –
3 x’s per
24 hours
equipment not in place
Organized around ADL
Rehab discharge not
communicated to unit
Patients not functionally
ready to go home
Patient / Family readiness
Pt education documented
On white board re: WHY
Education on Mobilization
Room set up to support
Chair, assists available
Chair / Assist devices availableStaff & Family
Available to support
Ventilator
Assistance
C r i t i c a l
C a r e S C N
Change Tools – Driver
DiagramOUTCOME PRIMARY DRIVERS
SECONDARY
DRIVERS
IDEAS FOR
PROCESS CHANGE
Patient
Mobilization
Put mobilization
Times on
whiteboard
Entire team
Says “we need
To Mobilize
Get family
engaged
Coordination &
Communication
Mobilize &
Monitor
Staff
“READY”
to mobilize
Patient
“ABLE”
to mobilize
Pain Meds
Timed to event
Organized
Around Unit
workflow
e.g. Rounds
Education &
Understanding
Best practice
Medical &
Functional
Readiness
Hospital
Resources
CREATIVE COMMUNICATION
Provincial Data Delirium Initiative
Table 1. Characteristics of patients at General system units
Total
(n=9772)
Ever Delirium
p value0 (n=5059) 1 (n=4713)
Male, n (%) 5622 2826 (50.27) 2796 (49.73) <.001
Age, yr, median (QR) 59 (45-69) 59 (45-69) 59 (59-69) .23
Admit type Urgent, n (%) 8481 4163 (49.09) 4318 (50.91) <.001
APACHEII score, median (QR) 22 (16-28) 19 (14-26) 24 (19-29) <.001
APACHEIII score, median (QR) 69 (51-92) 60 (45-83) 78 (6-98) <.001
52.78%
48.23%
Ever Delirium
No Yes
64.26 56.0250.14 49.02 46.88
40.32 40.28 38.69 36.6731.07
0
10
20
30
40
50
60
70
Ev
er
Deliri
um
%
Table 2. Characteristics of patients at General system unitsTotal
(n=9772
)
Delirium p
valu
e
No
(n=5059)
<=24hrs
(n=2965)
>24 hrs
(n=1748)
Total n (%) 9772 5059
(51.77)
2965
(30.34)
1748
(17.89)
Male, n (%) 5622 2826
(55.88)
1742(58.75
)
1054
(60.33)
0.00
2
Age, yr, median (QR) 59 (45-
69)
59(45-69) 58(45-69) 59 (46-70) 0.38
Admit type Urgent, n
(%)
8481 4163(82.32) 2727(91.97
)
1591
(91.02)
<.00
1
APACHEII score,
median (QR)
22 (16-
28)
19(14-26) 23(19-29) 25 (20-30) <.00
1
APACHEIII score,
median (QR)
69 (51-
92)
60(45-83) 76(58-96) 82 (63-
100)
<.00
1
51.77%30.34
%
17.89%
Delirium
No <=24 hours >24 hours
39.2
28.129.7 28.8
20.0
40.4
23.1
16.5
25.9
34.9
25.1
22.119.3
18.116.7 15.6 15.6 14.6 14.4
5.4
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
Deli
riu
m %
<=24 hours
18.53
25.41 25.47
38.82
24.93
36.68
24.55
40.01
26.19
43.29
25.48
39
32.47
23.63
17.69
28.22
22.76 22.0420.94
17.62 16.93 16.84 16.05 15.56
13.2 12.98 12.2510.92
8.767.58
0
5
10
15
20
25
30
35
40
45
50D
eli
riu
m %
<=24 hours >24 hours
p<.001
020
40
60
AP
AC
HE
II
No Delirium Delerium
p<.001
050
100
150
200
AP
AC
HE
III
No Delirium Delirium
Figure 4. APACHE
p<.001020
4060
AP
AC
HE
II S
core
No <=24 hours >24 hours
p<.001
050
100
150
200
AP
AC
HE
III S
core
No <=24 hours >24 hours
Delirium
Table 2. Outcomes for patients at General system units
totalEver Delirium
p value0 1
ICU outcome 0.04
Dead 1302 709 (14.01) 593 (12.58)
Hospital outcome 0.01
Dead 1842 904 (17.87) 938 (19.90)
ICU LOS, d,
median (IOR)
3.1 (1.6-
6.5)
2 (1.0- 3.7) 5.5 (2.9-
10.1)
<.001
HOSP LOS, d,
median (IOR)
10 (4-
23)
6 (2-15) 15 (7-33) <.001
14.0112.58
17.8719.90
0
5
10
15
20
25
No delirium Delirium
Mo
rta
lity
%
ICU In-hospital
p<.001
0.0
00
.25
0.5
00
.75
1.0
0
Pro
ba
bili
ty o
f B
ein
g in t
he I
CU
0 20 40 60Days
Ever delirium = No
Ever delirium = Yes
Kaplan-Meier Analysis of Delirium in the ICU Length of Stay
p<.001
0.0
00
.25
0.5
00
.75
1.0
0
Pro
ba
bili
ty o
f B
ein
g in
th
e H
osp
ital
0 30 60 90 120 150 180Days
Ever delirium = No
Ever delirium = Yes
Kaplan-Meier Analysis of Delirium in the Hospital Length of Stay
Table 2. Outcomes for patients at General system units
total
Delirium p
valu
e
No <=24
hours
>hours
ICU outcome
Dead 1302 709
(14.01)
363
(12.24)
230
(13.16)
0.08
Hospital outcome
Dead 1842 904
(17.87)
551
(18.58)
387
(22.14)
<.001
ICU LOS, d,
median (IOR)
3.1 (1.6
– 6.5)
2 (1-3.7) 4 (2.1-7.8) 8.1 (4.9-
13.5)
<.001
HOSP LOS, d,
median (IOR)
10 (4 -
23)
6 (2-15) 12 (5-29) 20 (11-39) <.001
14.0112.24 13.16
17.87 18.58
22.14
0
5
10
15
20
25
No <=24 hours >24 hours
Mo
rta
lity
%
ICU In- hospital
p<.001
0.0
00
.25
0.5
00
.75
1.0
0
Pro
ba
bili
ty o
f B
ein
g in t
he I
CU
0 20 40 60Days
No Delirium
Delirium<= 24 hours
Delirium > 24 hours
Kaplan-Meier Analysis of Delirium in the ICU Length of Stay
p<.001
0.0
00
.25
0.5
00
.75
1.0
0
Pro
ba
bili
ty o
f B
ein
g in t
he H
ospita
l
0 30 60 90 120 150 180Days
No delirium
Delirium <=24 hours
Delirium >24 hours
Kaplan-Meier Analysis of Delirium in the Hospital Length of Stay
0
5
10
15
20
25
30
35
day 1 day 2 day 3 day 4 day 5 day 6 day 7
Percentage
0
500
1000
1500
2000
2500
3000
3500
day 1 day 2 day 3 day 4 day 5 day 6 day 7
Patients
Timing of Development of
Delirium
Delirium Collaborative Data
C r i t i c a l
C a r e S C N
C r i t i c a l
C a r e S C N
C r i t i c a l
C a r e S C N
7.23% September screening compliance to 59.88% in April
C r i t i c a l
C a r e S C N
Provincial
C r i t i c a l
C a r e S C N
C r i t i c a l
C a r e S C N
C r i t i c a l
C a r e S C N
C r i t i c a l
C a r e S C N
C r i t i c a l
C a r e S C N
C r i t i c a l
C a r e S C N
C r i t i c a l
C a r e S C N
C r i t i c a l
C a r e S C N
Unit specific KPIs – Big
improvement performers!• Medicine Hat
o Ever Delirium –
• 58% @ baseline Jan-Apr 25%
• Royal Alex-o SBT eligibility assessed & documented
• 47% @ baseline April 83%
• South Health Campus- Calgaryo % of time pain & pain management discussed daily
• 75% @ baseline April 100%
C r i t i c a l
C a r e S C N
• Misericordia Hospitalo % of time eligible patients received 3 mobility events in 24hrs
• 40% @ baseline April 83%
• Chinook Regional Hospital-Lethbridgeo % of time RASS assessed and documented q4hr
• 12.28% @ baseline April 66%
• Foothills Hospital ICUo Significant pain
• 17.55% @ baseline April 11.98%
Unit specific KPIs – Big
improvement performers!
Adult ICUUrban vs Regional
C r i t i c a l
C a r e S C N
% of patient days with delirium
*Coronary Care units not included
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Base
line
Q3 (
16
/17
)
Q4
Q1(1
7/1
8)
Base
line
Q3 (
16
/17
)
Q4
Q1(1
7/1
8)
Base
line
Q3 (
16
/17
)
Q4
Q1(1
7/1
8)
Calgary Zone Edmonton Zone Regional Sites
% o
f p
atie
nt d
ays w
ith
de
liriu
m
Delirium Screening compliance is >85% for each
quarter
C r i t i c a l
C a r e S C N
*Coronary Care units not included
0
10
20
30
40
50
60
70
80
90
100
Base
line
Fe
b
Ma
rch
Apri
l
Ma
y
Base
line
Fe
b
Ma
rch
Apri
l
Ma
y
Base
line
Fe
b
Ma
rch
Apri
l
Ma
y
Calgary Zone Edmonton Zone Regional Sites
% o
f cp
mp
lian
ce
with
q4
hr
pa
in a
sse
ssm
en
tAdult ICU
% of compliance with pain assessment
95% target
complianc
e
C r i t i c a l
C a r e S C N
0
5
10
15
20
25
30
35
40B
ase
line
Fe
b
Ma
rch
Apri
l
Ma
y
Base
line
Fe
b
Ma
rch
Apri
l
Ma
y
Base
line
Fe
b
Ma
rch
Apri
l
Ma
y
Calgary Zone Edmonton Zone Regional Sites
% o
f assessm
ent w
ith s
ignific
ant
pain
% of Assessment with
Significant pain
*Coronary Care units not
included
C r i t i c a l
C a r e S C N
Agitation & Sedation
Assessment
0
10
20
30
40
50
60
70
80
90
100
Base
line
Fe
b
Ma
rch
Apri
l
Ma
y
Base
line
Fe
b
Ma
rch
Apri
l
Ma
y
Base
line
Fe
b
Ma
rch
Apri
l
Ma
y
Calgary Zone Edmonton Zone Regional Sites
% c
om
pla
ince
with
q4
hr
RA
SS
asse
ssm
en
t
*Coronary Care units not
included
95% target
compliance
Calgary Zone
C r i t i c a l
C a r e S C N
Delirium
0%
5%
10%
15%
20%
25%
30%
35%
40%
Ba
se
line
Q3
(16/1
7)
Q4
Q1
(17/1
8)
Ba
se
line
Q3
(16/1
7)
Q4
Q1
(17/1
8)
Ba
se
line
Q3
(16/1
7)
Q4
Q1
(17/1
8)
Ba
se
line
Q3
(16/1
7)
Q4
Q1
(17/1
8)
Ba
se
line
Q3
(16/1
7)
Q4
Q1
(17/1
8)
FMC CVICU FMC ICU PLC ICU SHC RGH
% o
f patient
days w
ith d
elir
ium
Calgary Zone Delirium
Delirium Screening compliance is >85% for each
quarter
C r i t i c a l
C a r e S C N
Pain Assessment
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
100.00
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
FMC CVICU FMC ICU PLC ICU SHC RGH
% o
f com
plia
nce to q
4hr
Pain
assessm
ent
Pain Assessment% of compliance time q4hr pain assessment
95% target compliance
C r i t i c a l
C a r e S C N
Significant Pain
0
5
10
15
20
25
30
35
40
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
FMC CVICU FMC ICU PLC ICU SHC RGH
% o
f assessm
ents
with s
ignific
ant
pain
Calgary Zone Significant Pain
C r i t i c a l
C a r e S C N
Agitation and Sedation
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
FMC CVICU FMC ICU PLC ICU SHC RGH
% o
f com
pla
ince to q
4hr
RA
SS
assessm
ent
Calgary ZoneAgitation and Sedation
95% target compliance
Edmonton Zone
C r i t i c a l
C a r e S C N
Delirium
0%
5%
10%
15%
20%
25%
30%
35%
40%
Ba
se
line
Q3
(16/1
7)
Q4
Q1
(17/1
8)
Ba
se
line
Q3
(16/1
7)
Q4
Q1
(17/1
8)
Ba
se
line
Q3
(16/1
7)
Q4
Q1
(17/1
8)
Ba
se
line
Q3
(16/1
7)
Q4
Q1
(17/1
8)
Ba
se
line
Q3
(16/1
7)
Q4
Q1
(17/1
8)
Ba
se
line
Q3
(16/1
7)
Q4
Q1
(17/1
8)
Ba
se
line
Q3
(16/1
7)
Q4
Q1
(17/1
8)
GNH MAZ CVICU MIS ICU RAH ICU SCH ICU UAH GSICU UAH Neuro
% o
f patient
days w
ith d
elir
ium
Edmonton Zone Delirium
Delirium Screening compliance is >85% for each
quarter
C r i t i c a l
C a r e S C N
Pain Assessment
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
100.00
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
GNH ICU MAZ CVICU MIS ICU RAH ICU SCH ICU UAH GSICU UAH Neuro
Edmonton Zone% compliance to q4hr pain assessment
95% target compliance
C r i t i c a l
C a r e S C N
Significant Pain
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
GNH ICU MAZ CVICU MIS ICU RAH ICU SCH ICU UAH GSICU UAH Neuro
Edmonton Zone Significant Pain
C r i t i c a l
C a r e S C N
Agitation & Sedation
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
GNH ICU MAZ CVICU MIS ICU RAH ICU SCH ICU UAH GSICU UAH Neuro
% o
f com
plia
nce w
ith q
4hr
RA
SS
assessm
ent
Edmonton Zone Agitation and Sedation
95% target compliance
Regional Hospitals
C r i t i c a l
C a r e S C N
Delirium
0%
5%
10%
15%
20%
25%
30%
35%
40%
Ba
se
line
Q3
(16/1
7)
Q4
Q1
(17/1
8)
Ba
se
line
Q3
(16/1
7)
Q4
Q1
(17/1
8)
Ba
se
line
Q3
(16/1
7)
Q4
Q1
(17/1
8)
Ba
se
line
Q3
(16/1
7)
Q4
Q1
(17/1
8)
Ba
se
line
Q3
(16/1
7)
Q4
Q1
(17/1
8)
CRH QEII MHRH NLRH RDRH
% o
f patient
days
with d
elir
ium
Regional HospitalsDelirium
C r i t i c a l
C a r e S C N
Pain Assessment
0
10
20
30
40
50
60
70
80
90
100
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
CRH ICU MHRH ICU RDRH ICU NLRH ICU QEII ICU
Regional Hospitals% of compliance q4hr pain assessment
95% target compliance
C r i t i c a l
C a r e S C N
Significant Pain
0
5
10
15
20
25
30
35
40
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
MHRH ICU RDRH ICU NLRH ICU QEII ICU
% o
f assessm
ents
with s
ignific
ant
pain
Regional Sites Significant Pain
C r i t i c a l
C a r e S C N
Agitation & Sedation
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
Ba
se
line
Fe
b
Ma
rch
Ap
ril
Ma
y
CRH ICU MHRH ICU RDRH ICU NLRH ICU QEII ICU
% o
f com
plia
nce to q
4hr
RA
SS
assessm
ent
Regional SitesAgitation and Sedation
95% target compliance
Pediatric ICU
C r i t i c a l
C a r e S C N
Delirium
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Baseline Q3 (16/17) Q4 Q1(17/18) Baseline Q3 (16/17) Q4 Q1(17/18) Baseline Q3 (16/17) Q4 Q1(17/18)
ACH STOL PCICU STOL PICU
% o
f patient
days w
ith d
elir
ium
Pediatric Hospitals% pf patient days with delirium
C r i t i c a l
C a r e S C N
95% target compliance
0%
5%
10%
15%
20%
25%
30%
35%
40%
Q3(16/17) Q4 Q1(17/18)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% o
f patient
days w
ith d
elir
ium
% o
f q
12hr
scre
enin
g c
om
pla
ince
ACH Delirium
Ever Delirium Screening Compliance
C r i t i c a l
C a r e S C N
95% target compliance
0%
5%
10%
15%
20%
25%
30%
35%
40%
Q3(16/17) Q4 Q1(17/18)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% o
f patient
days w
ith d
elir
ium
% o
f q
12hr
scre
enin
g c
om
pla
ince
Stollery PICU Delirium
Ever Delirium Screening Compliance
C r i t i c a l
C a r e S C N
0%
5%
10%
15%
20%
25%
30%
35%
40%
Q3(16/17) Q4 Q1(17/18)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% o
f patient
days w
ith d
elir
ium
% o
f q
12hr
scre
enin
g c
om
pla
ince
Stollery PCICU Delirium
Ever Delirium Screening Compliance
C r i t i c a l
C a r e S C N
Pain Assessment
0
10
20
30
40
50
60
70
80
90
100
Baseline Feb March April May Baseline Feb March April May Baseline Feb March April May
ACH STOL PICU STOL PCICU
% o
f cpm
plia
nce w
ith q
4hr
pain
assessm
ent
PediatricCompliance of pain assessment
95% target compliance
C r i t i c a l
C a r e S C N
Significant Pain
0
5
10
15
20
25
30
Baseline Feb March April May Baseline Feb March April May Baseline Feb March April May
ACH STOL PICU STOL PCICU
% o
f assessm
ent w
ith s
ignific
ant
pain
Pediatric Units Significant pain
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
My Team Members:
Mazankowski CVICU
Todd M.
Deanna P.
Zee Y.
Daniel G.
Damaris G.O.
Megan P.
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
My Team Members:
Kristin Ferguson Kari Litzenberger
Dr. Chris Grant Allison Friesen
Regrets:
Dr. Andre Ferland
Chris Coltman
FMC CVICU
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
My Team Members:
Dr. Terry Hulme
Melissa Redlich (Manager)
Nicole Nigel (PT)
Kelsey Slemko (Clincian)
Rachel Lessoway (RN)
Monica Nguyen (RN)
Lyle Geldof (RT)
Chelsey McBride (RN)
Allie Barcomb (RN)
Steph McLeod (RN)
Kirstin Junchniewicz (RN)
ROCKYVIEW ICU
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
My Team Members:
Representation from ICU Management, QI
Lead, Nursing and RRT Educators, Nurse
Clinician, RRT Supervisor, PT, OT,
Pharmacy and bedside RNs and RRTs.
Foothills Medical Centre ICU
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
My Team Members:
Alberta Children’s Hospital PICU
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
My Team Members:
PAWD-E Patrol: Alice Chan, Shannon Duncan, Dominic Cave, Laurance Lequier, Gonzalo Guerra, Lorraine Hodson, Christine MacDonald, Tamara Liber, Whitney Gendall, Just Kiew, Lara Sreibers Cindy Scouten, Archie Enano, Adele Benest, Sarah Bieganek,
Stollery Pediatric Critical Care
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
Jon Pryznyk - RRT Supervisor
Kari Taylor - CNE
Dr. Juan Posadas – Medical Director
Michelle Parsons - PT
Stephanie Oviatt - PT
Charissa Elton-Lacasse - NP
Myrriah Huyton - RN
Meaghan Wood - RRT
Jana Smith - NC
Rachel Taylor – Manager
Karolina Zjadewicz – QI Lead
Jeanna Morrissey – Delirium Practice Lead
Team Members:
South Health Campus ICU
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
(Insert team picture here)Our Multi disciplinary team includes: Management , Physician , Nursing , Pharmacy , PT , OT and Social Work
Robert , Carmen, Mike, Fay Twyla, Gillian, Jennifer, Krista Angela ,Geoff , Jennifer , Roxanne , Sandy , Kirby , Deanna , Phil , Jann , Kelly
RDRH ICU
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
Here is our team ready to combat delirium
Core Team Members:
Erica Kam
Heather Emmerzael
Heidi Cunningham
Laurie Sembaliuk
Melissa Ziober
Dr. Pierre Villeneuve
Grey Nuns Hospital Intensive Care Unit
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
My Team Members:
Dr. Ella Rokosh Kim Scherr
Wanda Power Gwen Bileski
Phuong Tien Michelle Campbell
Jill McLauchlin Olga Muradov
Melissa Black Alice (Sin Hang) Chan
Angie Grewal Eric Lau
Rhonda Schmidt Leanne Ellis
Trish O’Toole
Misericordia Community Hospital ICU
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
UAH Neuro. ICU
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
Team Members:
Dr. Gabriel Suen – ICU MD
Shirley Baumgartner – PCM
Glenda Corrigal – UM
Nancy Coyne – CNE
Sophia Lepore – RN
Beverly Lefebvre - RT
Kristine Hayday - PT
(Sturgeon Community Hospital- ICU)
C r i t i c a l C a r e S C N
MHRH I-rounds board
C r i t i c a l C a r e S C N
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
REPORT DATE: 2017-05-04 Delirium Report
2017-MarPatients Screened for Delirium: 3 patients out of 3
(100%)Patients with RASS Assessment: 3 (100%)Patients with ICDSC Assessment: 3 (100%)
2017-AprPatients Screened for Delirium: 1 patients out of 2
(50%)Patients with RASS Assessment: 1 (50%)Patients with ICDSC Assessment: 1 (50%)
ANNUAL REPORT: 2017Patients Screened for Delirium: 103 patients out of 117
(88%)Patients with RASS Assessment: 83 (71%)Patients with ICDSC Assessment: 85 (73%)-20170504
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
My Team Members:Kristen Davis
Joanne ShepherdJacinta Ziegler
Michelle PicardMarissa Storie
Cindy O’FlahertySandra Beida
Lacee TaylorAngie Dort
Dr. Gerald Nikoleychuk
QE II Regional Hospital ICU/CCU
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
Dr. Mike Meier Samantha Taylor
Salima Ismail Christopher Tham
Kelly Robinsons Laverne Gallagher
Jessica Hullman Renee Nason
Paula Roberts Karen Lee Brown
Jill Bech Lori Yurkiw
Lily Zhang
U of AGSICU/Burns
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
My Team Members:
Dr. E. Janzen
Riley Epp, RN
Spencer Bisley, RRT
Victor Kemble, RN
Alison Martin, RN
Stephanie Quan, RRT
Kathy Sassa, CNE
Jo Taylor, Unit Manager
Lethbridge Chinook Regional Hospital ICU
Scott Groves, RN
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
My Team Members
Pam Lund, RN (ICU Manager)
Katie Kirschner, RN
Lee Junlajeam, RT
Yejide Adeniji, PT
NLRH- Fort McMurray
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
My Team Members:
PLC ICU
Judy RRT supervisor
JasonNursing Attendant
TorieClinical Nurse Educator
MaureenPhysiotherapist
IlaUnit Manager
BrittanyNurse Clinician
C r i t i c a l C a r eS T R A T E G I CC L I N I C A LN E T W O R K
My Team Members:
Fran Gallant – Nurse Clinician
Sue Kujundzic – Nurse Clinician
Sammar Hussein - RN
Roy Poules - CNE
Maria Brix – Unit Manager
Jenny Mazuryk - Manager
Peter Lougheed Centre CCU